RESUMO
Background: While several scoring systems for the severity of anaphylactic reactions have been developed, there is a lack of consensus on definition and categorisation of severity of food allergy disease as a whole. Aim: To develop an international consensus on the severity of food allergy (DEfinition of Food Allergy Severity, DEFASE) scoring system, to be used globally. Methods Phase 1: We conducted a mixed-method systematic review (SR) of 11 databases for published and unpublished literature on severity of food allergy management and set up a panel of international experts. Phase 2: Based on our findings in Phase 1, we drafted statements for a two-round modified electronic Delphi (e-Delphi) survey. A purposefully selected multidisciplinary international expert panel on food allergy (n = 60) was identified and sent a structured questionnaire, including a set of statements on different domains of food allergy severity related to symptoms, health-related quality of life, and economic impact. Participants were asked to score their agreement on each statement on a 5-point Likert scale ranging from "strongly agree" to "strongly disagree". Median scores and percentage agreements were calculated. Consensus was defined a priori as being achieved if 70% or more of panel members rated a statement as "strongly agree" to "agree" after the second round. Based on feedback, 2 additional online voting rounds were conducted. Results: We received responses from 92% of Delphi panel members in round 1 and 85% in round 2. Consensus was achieved on the overall score and in all of the 5 specific key domains as essential components of the DEFASE score. Conclusions: The DEFASE score is the first comprehensive grading of food allergy severity that considers not only the severity of a single reaction, but the whole disease spectrum. An international consensus has been achieved regarding a scoring system for food allergy disease. It offers an evaluation grid, which may help to rate the severity of food allergy. Phase 3 will involve validating the scoring system in research settings, and implementing it in clinical practice.
RESUMO
To provide a means for comparing impact wrenches and similar tools, the international standard ISO 8662-7 prescribes a method for measuring the vibrations at the handles of tools during their operations against a cotton-phenolic braking device. To improve the standard, alternative loading mechanisms have been proposed; one device comprises aluminum blocks with friction brake linings, while another features plate-mounted bolts to provide the tool load. The objective of this study was to evaluate these three loading methods so that tool evaluators can select appropriate loading devices in order to obtain results that can be applied to their specific workplace operations. Six experienced tool operators used five tool models to evaluate the loading mechanisms. The results of this study indicate that different loads can yield different tool comparison results. However, any of the three devices appears to be adequate for initial tool screenings. On the other hand, vibration emissions measured in the laboratory are unlikely to be fully representative of those in the workplace. Therefore, for final tool selections and for reliably assessing workplace vibration exposures, vibration measurements should be collected under actual working conditions. Evaluators need to use appropriate numbers of tools and tool operators in their assessments; recommendations are provided.